I would like to ask opinions. I want new implants. Mine have lost volume and rippled due to weight loss. (Photo)

Do I need an uplift? I really don't want to. But I do want much bigger more high profile fake looking if you will! Can an uplift be done internally and will that be enough if needed? What kind of size implant would be good? I am a uk 32e now. At the moment they are very empty feeling and have rippled and don't feel as firm as they did. I had them done in 2009. I would appreciate any advice and help.

Doctor Answers 13

I would like to ask opinions. I want new implants. Mine have lost volume and rippled due to weight loss.

Thank you for the question and congratulations on your weight loss. Keep in mind as you are thinking about your goals that sometimes adjustment of the breast implant pockets (capsule adjustments) may be sufficient to achieve the outcome you are looking for.  This procedure may be what you are referring to as an "internal lift" or an internal bra procedure.  I would need to examine you to determine whether or not this procedure would be feasible in your case.  Otherwise, formal breast lifting and reaugmentation will be necessary.

Generally speaking, the best online advice I can give to ladies who are considering revisionary breast augmentation surgery is: 

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "up a cup size” or "DD cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.

3. Once you feel you have communicated your goals clearly, allow your chosen plastic surgeon to work with you in determining the best plan to achieve your goals.

I hope this, and the attached link (dedicated to revisionary breast augmentation surgery concerns), helps. Best wishes.


San Diego Plastic Surgeon
5.0 out of 5 stars 1,484 reviews

Redo breasts augmentation with mini lift

Dear Peanutty,
  Thanks for submitting your pictures. From the pictures, you appear to be full C cup size with level 2 ptosis(droopiness) and very large areolas.
 You did not provide info on the pocket location. As a rule, sub muscular pocket is a much better option because of the better coverage. If you have sub glandular pocket, it can be converted to sub muscular. 
 To become much larger, say, 32 DD, you will have to replace your present implants with volume that is bigger by 325 cc than your current implants size.
 I would strongly recommend a mini lift (donut) procedure at the same time, which will give you beautiful, perky and youthful breasts with more attractive areolas. Without the mini lift, in order to give you a nipple lift, the IMF (infra mammary fold ) will have to be lowered significantly, lowering your breasts position on the chest even further than the present low position which is not attractive and looks old.
 You will have, most likely, to have capsulotomy (scar release), in order to enlarge the pocket and suit the larger implants, and give your breasts a more natural look.
  Always , consult with experienced board certified plastic surgeons who perform lots of redo breasts augmentation surgeries in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive.
            Best of luck,
                           Dr Widder

Shlomo Widder, MD
McLean Plastic Surgeon
4.8 out of 5 stars 124 reviews

Implant exchange

Dear Peanuttyleon,
With a larger implant you should not need a lift.  Be sure to consult with a certified plastic surgeon to discuss your options and expectations, such as areolar widening and aging of large implants.  Good luck!

Kenneth R. Francis, MD, FACS
Manhattan Plastic Surgeon
4.6 out of 5 stars 46 reviews

Capsulectomy and implant replacement

You should have a capsulectomy with implant replacement, not a lift. Everything should be done internally.  You should use smooth round high profile implants.

A lift with an implant is controversial for two reasons. First, when you perform a lift you are making everything tight and closing the wounds under tension. It you add the expansive forces of the implant at the same time, you are fighting against yourself. There are forces on the wound which try to make them separate, which results in wider, thicker, more irregular scars. In the worst case, the wounds will open. So compromises are usually made in the operating room by the surgeon because they cannot close the lift wounds over the appropriate sized implant. Either less of a lift is performed so that the skin is not as tight and therefore there is less tension on the closure. Or a smaller implant than would be appropriate is used so as to decrease the expansive forces. Either way, you are compromising the aesthetic outcome. Often the outcome is so compromised that a second revision surgery is required. If however, you plan to have the lift first and then the augmentation after everything has healed, then you have two operation that are planned, both with much lower risk than the combined mastopexy/augmenation. The outcomes of the two meticulously planned operations are much better and a more aesthetically pleasing, and a safer outcome is achieved.

The second reason the combination of mastopexy and augmentation is controversial is because of the risk of nipple necrosis (death of the nipple). By making the skin tight for the lift, you are putting external pressure on the veins that supply the nipple. By putting an expansive force on the undersurface of the breast with an implant, you are putting pressure on the thin walled veins that supply the nipple. If the pressure by squeezing the veins between the implant and the skin is greater than the venous pressure in the veins, the flow will stop. If the venous outflow stops, the arterial inflow is stopped. If the arterial inflow is stopped, there is no oxygen for the healing wounds and the tissue dies.

Placing the implant on top of the muscle in combination with a lift puts the blood supply to the nipple at a much higher risk because in addition to the issue of pressure on the veins, you have to divide the blood vessels that are traveling from the pectoralis muscle directly into the breast (and to the nipple) in order to place the implant between the breast tissue and the muscle. This adds a third element of risk to an already risky operation. Mastopexy/augmenation with sub glandular implant placement is by far the riskiest way to address your anatomic question.

Gary Lawton, MD, FACS
San Antonio Plastic Surgeon
4.9 out of 5 stars 135 reviews

A lift is a good option

If you do not want to be larger, a different implant will not help you. It would be way too large. A lift will significantly improve the shape, rippling, and nipple position. This is at the price of visible scars.

Michael S. Beckenstein, MD
Birmingham Plastic Surgeon
4.9 out of 5 stars 18 reviews

I want new implants. Mine have lost volume and rippled due to weight loss.

Hi,

Just a word of caution. The larger the implant, the heavier it is, the sooner they will sag. I suggest you have them placed behind the muscle to give them much needed support. You will need a lift in order to achieve long term results. Do not allow someone to just replace them with larger implants without doing a lift of some sort. You won't be happy with the outcome.

I hope this helps.
Best wishes and kind regards,

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 222 reviews

Weight loss and change in appearance of breasts

I guess the first thing I would ask is are these saline or silicone and are they over or under the muscle?  If they are over the muscle and you go bigger, they are only going to sag more. Saline tends to ripple more than silicone and over more than under. I didn't catch what the size of the current implants is.  If you want the "fake" look, I would suggest going under the muscle and having a lift.  The profile you need will depend on  your chest dimensions and the volume of the implant that you choose. Of course all these questions are best answered through an in-person evaluation.

Paul W. Loewenstein, MD
Milwaukee Plastic Surgeon
4.8 out of 5 stars 29 reviews

Do I need a lift?

Thank you for your question. It appears that you would benefit from a breast lift and possibly an implant exchange. Without an examination it would be difficult to determine if an internal lift would be beneficial. However, from the pictures  it appears that you would be better off with an external breast lift. There can also be significant cost to an internal lift if an acelluar dermal matrix is needed to support the tissues. My personal opinion based on your photos would be for an external mastopexy which would require visible incisions.  Hope this helps.

Dr.Rast

Jon E. Rast, MD
Kansas City Plastic Surgeon
5.0 out of 5 stars 32 reviews

Breast Augmentation - Implant Exchange

Thank you for your question. I agree that exchanging your implants out for larger ones would improve the appearance of your breasts. A small crescent or circumareolar lift could be beneficial. This would also reduce the size of your areolas. Please have an in-person consultation with a board certified plastic surgeon who specializes in cosmetic surgery.



 

Steven J. Rottman, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 77 reviews

Implant Revision

Dear Peanuttyleon,

The decision on whether or not to have a breast lift can be challenging as many women do not want to add visible scarring to their breasts.  However, you need to decide what is more important to you - breast shape or the scarring.  If you desire very high, rounded, "fake looking" breasts, then you will benefit from a lift and implant exchange.   Also, your pictures make me wonder if your implants are above your muscle and if they are not you might benefit from a submuscular conversion.  If you are happy with your current implant location, then larger implants will help round out your breasts and this can most likely be performed through the same scar that you already have.  Without a breast lift though, your implants will stay in the same relative position as to where they are now.  If you are desiring a lot of cleavage or more elevated, rounded breasts then you will probably be happiest with a breast lift.  A breast lift does add scars but more people find if reasonable trade off for the improved shape.

Good luck,

Jennifer Boll, MD

Jennifer Boll, MD
Tempe Plastic Surgeon
5.0 out of 5 stars 9 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.